Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Fo W/O Joint Custom T1
Low
$1
Average
$188
Median
$175
High
$652
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
56 hospitals; the 90th percentile is 31.2× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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60 hospital rates
iThe hospitals that file a Medicaid rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Spaulding Rehabilitation Hospital Boston Charlestown, MA percent of total billed charges · outpatientfrom % of charges | 1 | $168 | $168 | — | — | 35 | $168 – $168 |
| 2 | Eskenazi Health Indianapolis, IN facility · fee schedule · both | 1 | $156 | $156 | — | — | 2–20 | $156 – $156 |
| 3 | Eskenazi Health Indianapolis, IN facility · fee schedule · outpatient | 1 | $156 | $156 | — | — | 1–10 | $156 – $156 |
| 4 | Spaulding Rehabilitation Hospital Cape Cod Sandwich, MA percent of total billed charges · outpatientfrom % of charges | 1 | $169 | $169 | — | — | 1–10 | $169 – $169 |
| 5 | ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient | 1 | $175 | $175 | — | — | — | $175 – $175 |
| 6 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges | 1 | $138 | $138 | — | — | — | $138 – $138 |
| 7 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges | 1 | $112 | $112 | — | — | — | $112 – $112 |
| 8 | Allina Health Systems Shakopee, MN facility · fee schedule · outpatient | 1 | $134 | $134 | $105 | 78% | — | $29 – $238 |
| 9 | Allina Health Systems MN; 1175 Nininger Road. Hastings, MN facility · fee schedule · outpatient | 1 | $134 | $134 | $105 | 78% | — | $29 – $238 |
| 10 | Allina Health Systems Owatonna, MN facility · fee schedule · outpatient | 1 | $134 | $134 | $105 | 78% | — | $29 – $238 |
| 11 | Allina Health Systems Ulm, MN facility · other · outpatient | 1 | $126 | $126 | $115 | 91% | — | $11 – $240 |
| 12 | Allina Health Systems MN 55443; 550 Osborne Road NE. Fridley, MN facility · fee schedule · outpatient | 1 | $134 | $134 | $105 | 78% | — | $29 – $238 |
| 13 | Allina Health Systems Cambridge, MN facility · fee schedule · outpatient | 1 | $134 | $134 | $105 | 78% | — | $29 – $238 |
| 14 | Allina Health Systems River Falls, WI facility · fee schedule · outpatient | 1 | $134 | $134 | $105 | 78% | — | $29 – $238 |
| 15 | Allina Health Systems Minneapolis, MN facility · fee schedule · outpatient | 1 | $134 | $134 | $105 | 78% | — | $29 – $238 |
| 16 | Allina Health Systems Buffalo, MN facility · fee schedule · outpatient | 1 | $134 | $134 | $105 | 78% | — | $29 – $238 |
| 17 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $201 | $201 | — | — | — | $201 – $201 |
| 18 | CentraState Medical Center Freehold Township, NJ percent of total billed charges · bothfrom % of charges | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 19 | Chilton Medical Center Pompton Plains, NJ percent of total billed charges · bothfrom % of charges | 1 | $76 | $76 | — | — | — | $76 – $76 |
| 20 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CARMEL CARMEL, IN fee schedule · both | 2 | $257 | $257 | $23 | 9% | — | $234 – $281 |
| 21 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CRAWFORDSVILLE CRAWFORDSVILLE, IN fee schedule · both | 1 | $234 | $234 | — | — | — | $234 – $234 |
| 22 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH CROWN POINT CROWN POINT, IN fee schedule · both | 14 | $234 | $245 | $20 | 8% | — | $234 – $281 |
| 23 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH DYER DYER, IN fee schedule · both | 14 | $234 | $246 | $20 | 8% | — | $234 – $281 |
| 24 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH INDIANAPOLIS INDIANAPOLIS, IN fee schedule · both | 16 | $234 | $244 | $19 | 8% | — | $234 – $281 |
| 25 | FRANCISCAN ALLIANCE, INC. dba FRANCISCAN HEALTH LAFAYETTE LAFAYETTE, IN fee schedule · both | 2 | $257 | $257 | $23 | 9% | — | $234 – $281 |
← Payers reporting HCPCS L3933 · Snapshot 20261111T120946Z-9134e7f7